Hospitals and Health Care

February 8th, 2010

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“Following the release of the original data, we began a number of initiatives that are still ongoing toward defining the patient’s wishes at the time of admission regarding the extent of care that he or she wants provided.” But Press also notes that many patients and families served by his hospital “really desire very aggressive care. We are changing this to the extent it can be changed, but it is a cultural change.”

Cedars-Sinai Medical Center in Los Angeles ranked second for aggressiveness of end-of-life care. Thomas M. Priselac, the hospital’s president and CEO, says that while Dartmouth is doing “very important work,” without more detailed hospital-specific data “it raises more questions than it provides answers.”

A key question, of course, is whether patients are being kept alive longer in the regions that spend more money and deliver more aggressive care. “To judge survival, you have to look at people who are similarly ill and then follow them forward over time,” says Elliott S. Fisher, M.D., Wennberg’s longtime research collaborator.” And we’ve done that.” Their study of 969,325 Medicare beneficiaries hospitalized nationwide for three common conditions – colon cancer, heart attack, and hip fracture – published in the Feb. 18, 2003, issue of the Annals of Internal Medicine, analyzed the follow-up tests and treatments the patients received for up to five years after their very similar initial treatment.

Patients in the highest-spending areas received 60 percent more treatment than those in the lowest-spending areas, but the extra care didn’t seem to help at all, and it made some things worse. Patients in the high-spending, aggressive-care regions waited longer in emergency rooms and doctors’ offices than patients in lower-spending regions did. They were less likely to get recommended preventive treatments, such as aspirin to prevent future heart attacks, or appropriate immunizations. They were slightly more likely to die, and those who didn’t die weren’t any better off in terms of their ability to function in daily life. And overall they were no more satisfied with their care.

Other research groups have had similar findings using different methods.

A state-by-state score card on health system performance was issued in 2007 by the Commonwealth Fund, and independent health-quality research group. It graded such factors as overall population health, quality of care, access to care, and avoidable hospitalizations. Of the 13 states with the best scores, 10 have below-average end-of-life costs. And the three states in the Dartmouth study that spend the most on end-of-life health care – New York, New Jersey, and California – ranked 22nd, 26th, and 39th, respectively, in the Commonwealth Fund overall ranking.

A February 2008 study by the nonpartisan Congressional Budget Office found a reverse correlation between per capita Medicare spending and care quality. The percentage of patients hospitalized with heart attacks, pneumonia, and heart failure who get recommended treatments is lower in the higher-spending areas.

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Get Better Care, No Matter Where

February 4th, 2010

Tips for coping with a Complicated System

For people with serious long-term illnesses, navigating America’s health-care system can be daunting. Here’s what patients and family members can do to increase the chances of getting the best, most humane treatment.

1. Know your hospital

It pays to know what type of care to expect from hospitals in your area. Some are better than others at managing long-term conditions in a way that prevents the need for frequent hospitalizations and specialist visits, and the accompanying risks of infections and medical errors. To find out where your hospital stands, check the free tool at www.ConsumerReportsHealth.org.

What you can do:

  • If you have a choice, consider using a doctor attached to a hospital that practices conservative care.
  • Work with your primary-care doctor, or the specialist in charge of your specific condition, on preventive measures that can help you avoid unneeded hospitalizations.
  • When hospital stays are needed, try to ensure that a family member or friend is there whenever possible to monitor the patient’s care.

2. Ask about pros and cons

Just because a test or treatment can be done doesn’t mean it should be done. “Every intervention can create complications,” says Donald M. Berwick, M.D., president and CEO of the Institute for Healthcare Improvement, a not-for-profit organization based in Cambridge, Mass.

What you can do:

  • For tests, ask: Will this test change the way you treat the disease? If not, what is the benefit of doing it? Is this test likely to lead to follow-up tests, biopsies, or other diagnostic procedures? How will this benefit my health?
  • For treatments, ask: Is this likely to extend my life, and if so, for how long? How do its side effects and risks compare with the symptoms and risks of my disease itself? What will happen if I do not have the treatment?

3. Push for Coordination

Having many doctors involved in your care can lead to confusion and miscommunication. “The likelihood of a medication error skyrockets when you receive care from multiple independent practitioners,” says Eric A. Coleman, M.D., director of the Care Transitions Program at the University of Colorado Health Sciences Center.

What you can do:

  • Develop a good, long-term relationship with a primary-care physician. When medical problems arise, ask this doctor or your main specialist to coordinate all of your treatment.
  • Keep and update your own medical record. Whenever you get care from any other doctor, hospital, laboratory or clinic, have a record of it sent to your primary-care doctor and to yourself.
  • Keep an up-to-date list of all your medications, including prescription drugs, over-the-counter drugs, and dietary supplements. Include brand and generic name, dosage strength (such as 10 mg), and dosing schedule (such as once a day). Note any drugs that have caused bad side effects.

4. Mind the transitions

Many errors occur during transfers in the hospital, or to home, a rehab center, or a nursing home. “We reimburse physician care and hospital care, but we don’t reimburse care coordination,” says Mary Naylor, Ph.D., director of the Center for Transitions and Health at the University of Pennsylvania School of Nursing. “Often primary-care doctors and specialists don’t even talk to each other, so the follow-up care after hospitalization may be provided by a physician who doesn’t even know the patient was hospitalized.”

What you can do:

  • Do not assume your primary-care doctor knows you have entered or left the hospital. Make a call for yourself if necessary, and be sure to fill out forms authorizing the hospital to send your doctor records of your stay.
  • Ask for “medication reconciliation” when moving from one health-care setting to another, including your home. Going over all medications, especially those prescribed in the most recent setting, helps you make sure you are getting all the medications you need without duplications or harmful interactions.
  • Do not leave the hospital without completely understanding and signing off on the plan for follow-up care, who is going to arrange for and provide it, and how to get in touch with that person. And make sure you and your doctor receive the results of any tests taken in the hospital.

5. Have ‘the talk’

Families who have lost loved ones after strenuous courses of invasive treatments often say they regret not having recognized sooner that things were going downhill, and adjusting plans and expectations accordingly. “If someone has progressive cancer and is 87, and her kidneys are failing, and doctors recommend ever more treatments for every disease, you need to ask what the larger plan is,” says Ira Byock, M.D., director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

What you can do:

  • If many doctors are involved in a case, try to get them together to discuss the patient’s overall condition and outlook. You might have to be insistent to get this to happen.
  • Ask for a consultation with a palliative-care service for patients who are seriously ill and receiving aggressive care. Palliative specialists are trained to consider the patients’ entire medical and personal situation and to focus on symptom management and quality of life alongside any curative treatments that are still being tried.

6. Think twice about drastic measures

More aggressive hospitals more often use treatments such as feeding tubes and cardiopulmonary resuscitation in patients near death. But those measured might not extend life for long. if at all, and can be, uncomfortable. In regions with aggressive care, “families report more unmet needs and lower satisfaction,” says Joan Teno, M.D., professor of community health at Brown University Medical School.

What you can do:

  • Every adult should have an “advance directive” (available at www.caringinfo.org). It gives your preferences for care in the event you are ill with no prospect of recovery and unable to express your wishes.
  • Consider hospice care for a patient who, in the opinion of doctors, is likely to die within six months. Studies show that patients receiving hospice care on average live slightly longer than those with the same illnesses who are not in hospice.
  • Don’t be pressured into agreeing to invasive life-support treatments, such as feeding tubes, without a thorough discussion of the patients prognosis, personal preferences (if known), and overall condition.

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In Defense of ‘More’

February 1st, 2010

The Dartmouth Atlas ranked NYU Langone Medical Center in New York City No.1 in the nation among hospitals/medical schools for aggressive care and spending. Its chief medical officer, Robert Press, M.D., said the hospital was concerned when rankings first came out, in the 2006 edition of the Atlas.

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Transplant tourism poses ethical dilemma for US doctors

Posted on 28 January 2010 in Uncategorized by admin

A recent case study by doctors at Mount Sinai Hospital in New York examined the ethical issues posed by transplant tourism, an offshoot of medical tourism, which focuses solely on transplantation surgery.

Many American transplant professionals frown on the practice of transplant tourism where patients travel to countries such as China, India, and the Philippines for their transplantation.

These transplant tourists may be subject to sub-standard surgical techniques, poor organ matching, unhealthy donors, and post transplant infections, prompting U.S. health care institutions to refuse treatment of these patients upon return to the U.S. Medical associations have responded with transplant tourism policies and guidelines to advise clinicians on the ethics of caring for transplant tourists.

Full details of the study appear in the February issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD). Some might think of transplant or medical tourism as merely a fictional plot from one of Robin Cook’s medical thriller books (Foreign Body).

However, given the critical shortage of available organs in the U.S., transplant tourism has grown in popularity among patients awaiting transplantation. Currently, the United Network of Organ Sharing (UNOS) reports there are more than 105,000 Americans on the transplant candidate waiting list with more than 15,000 patients awaiting a liver transplant. Furthermore, UNOS data shows a decline in donorship with living donor numbers decreasing by 1.7% and deceased donors down by 1.2% in 2008.

In the current case, a 46-year-old Chinese accountant (HQ) was placed on the UNOS transplant registry with a Model for End Stage Liver Disease (MELD) score of 18 that increased to 21 while on the candidate waitlist for over a year (MELD scores range from 6 for those least ill through 40 for those most sick).

HQ then traveled to the People’s Republic of China (PRC) and was transplanted two weeks after arrival. After transplantation, HQ returned to the Mount Sinai program requesting follow-up care, which was provided. HQ then developed biliary sepsis requiring hospitalization and re-transplantation seemed to be the only viable option.

“While the patient was a medically suitable candidate, team members disagreed if it were indeed, morally right to provide him with a transplant,” said Thomas Schiano, M.D., one of the case clinicians and lead author of this study.

Ultimately, the transplant team proceeded with a liver transplant for HQ and he is currently doing well. “Our consensus to transplant was based on the relevant principles of medical ethics—non-judgmental regard, beneficence, and fiduciary responsibility,” added Dr. Schiano.

The study authors estimate that more than 400 patients received transplants abroad with 75% of those taking place between 2004 and 2006.

Of those transplant tourists, 40% reside in New York and California, and the majority these patients traveled to the PRC, where organs from executed prisoners have been used in transplantations.

Although transplant tourism is not held in high regard, the practice violates neither current U.S. law nor the National Organ Transplant Act. Current UNOS policies allow a small percentage of each center’s transplants to be allotted for foreign nationals, essentially allowing for transplant tourism within the U.S.

Over the last few years, professional associations have established transplant tourism policies to provide guidance to clinicians and uphold the principles of medical ethics.

The AASLD and International Liver Transplant Society (ILTS) have positions against the exploitation of donors, the recovery of organs from executed prisoners, and condemned the use of paid living donors. Similarly, the American Society of Transplantation declares that optimal medical care should not be withheld from those recipients who have chosen to receive transplants as “tourists” from abroad.

“Unfortunately, little guidance from societal statements are provided to transplant centers and the professionals in the trenches dealing with transplant tourists seeking care,” Dr. Schiano stated. Given the shortage of available organs, more patients may resort to transplant tourism as an option.

“Although we do not condone all of the practices associated with transplant tourism, it is our duty to provide all transplant patients with the same compassionate care and support, whether their transplantation was performed in the U.S. or abroad,” concluded Dr. Schiano.

To build awareness of the need for organ donors, February 14, 2010 is designated as National Donor Day in the U.S. The Department of Health and Human Services provides further information on National Donor Day.

Source: Wiley-Blackwell – esciencenews.com

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Increased International Tourists Arrivals in Turkey

Posted on 28 January 2010 in Uncategorized by admin

Despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.

With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.

Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.

Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.

Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.

“Medical Tourism to Drive Tourism Industry in Turkey

As per recently released report “Turkey Tourism Industry by 2013?, despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.

With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.

Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.

Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.

Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.”

Source: Earthtimes.org

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Geography and Health Care

January 29th, 2010

In some areas of the country, seriously ill patients have trouble escaping futile and often painful over-treatment. Jean Callahan, a social worker and attorney with the Vera Institute of Justice, a New York City public-interest group, became the court-appointed guardian for a 90-year-old bedridden woman so completely unresponsive that Callahan never even found out whether she spoke English. She had a feeding tube, but her stomach could not process the food. Both feet and lower legs had gangrene. The woman’s doctors “brought us into the case to consent to the amputation of one of her legs, but because the hospital considered the surgery to be life sustaining, we didn’t really have the legal power to say no,” Callahan says. “It was obvious to everyone around her that she was dying, but when we attempted to have her moved to hospice, the doctor said, ‘No, I don’t think she’s ready. They eventually amputated both of her legs, and she continued to get aggressive treatment, including intravenous antibiotics. In the end, she died of an infection.”

So, why does the health-care system serve up so much more care in New York than in Iowa? “Doctors decide who needs health care, what kind, and how much but have surprisingly little information on what the ‘right’ amount actually is,” says Dartmouth’s Wennberg.

If a patient has heart failure, there is little valid evidence, and no clear rules, about when to ask a patient to return for a follow-up visit, when to hospitalize him, or at what point to admit him to the ICU. “When faced with the uncertainty of medicine, physicians will use available capacity up to its point of exhaustion, no matter how much capacity there is,” the Atlas says.

Also, most American doctors are paid per visit, test, or procedure, rather than being on a salary. So the more they do to patients, the more money they make.

“If you live in Fort Myers, Fla., you’re two or three times more likely to get your knee replaced than if you live in Miami,” Wennberg says, “because there are more orthopedic surgeons in Fort Myers on the lookout for patients than there are in Miami.”

The exception to this rule helps prove it. A few common conditions – fractured hips and appendicitis, for instance – have a clear-cut diagnosis, and the need for hospitalization is universally accepted. Regardless of the local supply of hospital beds, the rates of initial hospitalization for those conditions are virtually identical in all regions.

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Your Result May Vary

January 26th, 2010

The amount of medical care that people get for serious illnesses varies enormously from place to place. In the last two years of life, the average patient spent 11 days in the hospital in Bend, Ore., and 35 days in Manhattan. In those same two years, patients visited the doctor an average of 34 times in Ogden, Utah, and 109 times in Los Angeles.

The Dartmouth Atlas based those findings on the Medicare claims records of millions of patients who died from (in order of prevalence) congestive heart failure, chronic pulmonary (lung) disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease. Together those ailments account for about 90 percent of deaths of people older than 65.

Over the years, Dartmouth research has yielded some startling insights:

  • The local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions have. The more medical resources a region has, the more aggressive the treatments are.
  • In the regions that deliver the most care, patients have a slightly higher death rate than patients with the same conditions treated in areas that treat less aggressively.
  • Patients treated most aggressively are no more satisfied with their care.
  • The cost differences are vast. Average Medicare spending over the last two years of life for all hospitals ranged from a high $181,143 in Manhattan to a low of $29,116 in Dubuque, Iowa.

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Transplant tourism poses ethical dilemma for US doctors

Posted on 28 January 2010 in Uncategorized by admin

A recent case study by doctors at Mount Sinai Hospital in New York examined the ethical issues posed by transplant tourism, an offshoot of medical tourism, which focuses solely on transplantation surgery.

Many American transplant professionals frown on the practice of transplant tourism where patients travel to countries such as China, India, and the Philippines for their transplantation.

These transplant tourists may be subject to sub-standard surgical techniques, poor organ matching, unhealthy donors, and post transplant infections, prompting U.S. health care institutions to refuse treatment of these patients upon return to the U.S. Medical associations have responded with transplant tourism policies and guidelines to advise clinicians on the ethics of caring for transplant tourists.

Full details of the study appear in the February issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD). Some might think of transplant or medical tourism as merely a fictional plot from one of Robin Cook’s medical thriller books (Foreign Body).

However, given the critical shortage of available organs in the U.S., transplant tourism has grown in popularity among patients awaiting transplantation. Currently, the United Network of Organ Sharing (UNOS) reports there are more than 105,000 Americans on the transplant candidate waiting list with more than 15,000 patients awaiting a liver transplant. Furthermore, UNOS data shows a decline in donorship with living donor numbers decreasing by 1.7% and deceased donors down by 1.2% in 2008.

In the current case, a 46-year-old Chinese accountant (HQ) was placed on the UNOS transplant registry with a Model for End Stage Liver Disease (MELD) score of 18 that increased to 21 while on the candidate waitlist for over a year (MELD scores range from 6 for those least ill through 40 for those most sick).

HQ then traveled to the People’s Republic of China (PRC) and was transplanted two weeks after arrival. After transplantation, HQ returned to the Mount Sinai program requesting follow-up care, which was provided. HQ then developed biliary sepsis requiring hospitalization and re-transplantation seemed to be the only viable option.

“While the patient was a medically suitable candidate, team members disagreed if it were indeed, morally right to provide him with a transplant,” said Thomas Schiano, M.D., one of the case clinicians and lead author of this study.

Ultimately, the transplant team proceeded with a liver transplant for HQ and he is currently doing well. “Our consensus to transplant was based on the relevant principles of medical ethics—non-judgmental regard, beneficence, and fiduciary responsibility,” added Dr. Schiano.

The study authors estimate that more than 400 patients received transplants abroad with 75% of those taking place between 2004 and 2006.

Of those transplant tourists, 40% reside in New York and California, and the majority these patients traveled to the PRC, where organs from executed prisoners have been used in transplantations.

Although transplant tourism is not held in high regard, the practice violates neither current U.S. law nor the National Organ Transplant Act. Current UNOS policies allow a small percentage of each center’s transplants to be allotted for foreign nationals, essentially allowing for transplant tourism within the U.S.

Over the last few years, professional associations have established transplant tourism policies to provide guidance to clinicians and uphold the principles of medical ethics.

The AASLD and International Liver Transplant Society (ILTS) have positions against the exploitation of donors, the recovery of organs from executed prisoners, and condemned the use of paid living donors. Similarly, the American Society of Transplantation declares that optimal medical care should not be withheld from those recipients who have chosen to receive transplants as “tourists” from abroad.

“Unfortunately, little guidance from societal statements are provided to transplant centers and the professionals in the trenches dealing with transplant tourists seeking care,” Dr. Schiano stated. Given the shortage of available organs, more patients may resort to transplant tourism as an option.

“Although we do not condone all of the practices associated with transplant tourism, it is our duty to provide all transplant patients with the same compassionate care and support, whether their transplantation was performed in the U.S. or abroad,” concluded Dr. Schiano.

To build awareness of the need for organ donors, February 14, 2010 is designated as National Donor Day in the U.S. The Department of Health and Human Services provides further information on National Donor Day.

Source: Wiley-Blackwell – esciencenews.com

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Increased International Tourists Arrivals in Turkey

Posted on 28 January 2010 in Uncategorized by admin

Despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.

With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.

Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.

Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.

Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.

“Medical Tourism to Drive Tourism Industry in Turkey

As per recently released report “Turkey Tourism Industry by 2013?, despite the ongoing downturn faced by the tourism industry around the world, tourism industry in Turkey has reported significant growth rate in recent time. International tourists arrivals has increased by 2.7% in 2009 over 2008 as compare to negative growth faced by world tourism industry.

With strong government efforts and increasing popularity of Turkey as a tourism destination, the international tourist arrivals in Turkey is expected to increase at a health rate of over 10% in coming four years, with outbound and domestic tourism is also expected see the high growth rates.

Medical tourism is expected to see a maximum growth in coming years. Medical tourists are expected to increase by over 20% in coming years. Increasing healthcare costs in European countries and developing healthcare infrastructure in Turkey will drive the growth of medical tourism in Turkey. A part from that marine tourism and golf tourism is also expected to see a huge growth in coming years.

Turkey tourism industry by 2013 report provides an insight into the Turkish tourism market. It evaluates the past, present and future scenario of the Turkish tourism market and discusses the key factors which are making Turkey a potential tourism destination. Report deeply analysed the different parameters of tourism industry, including inbound tourism, domestic tourism, outbound tourism, medical tourism, hotel industry etc.

Report provides the future forecast till 2013 for the major tourism indicators. Report also covers the major players in the tourism industry including major hotel chains and airlines.”

Source: Earthtimes.org

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Too Much Treatment?

January 22nd, 2010

Aggressive Medical Care Can Lean to More Pain, with No Gain

For many consumers and their doctors, good health care means seeing as many specialists as you want. It means undergoing frequent rounds of diagnostic tests, such as CT scans, to make sure everything is going well. And when you’re seriously ill, it means prolonged hospital stays and every conceivable treatment.

Though the idea that more health care is better seems to make intuitive sense, recent research has shown that none of the above necessarily helps you live better or longer. In fact, too much medical care shorten your life.

Those findings grew out of the 2008 Dartmouth Atlas of Health Care study and almost three decades of research by John E. Wennberg, M.D., and colleagues at Dartmouth Medical School (available at www.dartmouthatlas.org). Their 2008 Atlas study of 4,732,448 Medicare patients at thousands of U.S. hospitals from 2001 through 2005 found tremendous variation in the way people with serious illnesses such as heart failure and cancer were treated during the last two years of their lives. Some regions used two or three times the medical and financial resources than others.

Other Dartmouth research has found that patients with serious conditions who are treated in regions that provide the most aggressive medical care – have the most tests and procedures, see the most specialists, and spend the most days in hospitals – don’t live longer or enjoy a better quality of life than those who receive more conservative treatment.

Patients treated most aggressively are at increased risk of infections and medical errors that come from uncoordinated care (such as two doctors prescribing the same drug or clashing ones). They also receive poorer-quality care, spend a lot more money on co-pays, and are least satisfied with their health care, the Dartmouth research has found.

The chronically ill are not the only ones vulnerable to overly aggressive care. Consider the case of a middle-aged IBM executive from the New York City area who experienced chest pain. He went directly to a cardiologist, who ordered a full workup, including a CT scan of his chest. The scan found no heart problem, but at the edge of the film the radiologist noticed “something funny” in the neck area. A neck surgeon performed a biopsy and found nothing wrong. The cardiologist then performed an angiogram, a test done by threading a catheter through the blood vessels from the groin to the heart. Complications from that procedure landed the executive in the hospital for a brief period. By the time it was over, his bills were more than $150,000 and he still had no diagnosis. Eventually the pain disappeared on its own.

That was the medical history told to internist Paul Grundy, M.D., director of health-care technology and strategic initiatives at IBM headquarters in Armonk, N.Y., when months later he met with the executive, whose chest pain had returned. Grundy asked him what he was doing at the time. “Oh, we started gardening again,” the man told him. It turned out that overzealous use  of his string trimmer had stained a chest muscle, a condition that required no treatment other than an over-the-counter pain reliever. None of the high priced specialists (some call them the “partialists”) had considered muscle strain, a common condition often mistaken for heart pain.

Few Americans are aware of the dangers of this type of unneeded testing and over reliance on specialists. Instead, most fear that their health problems will be undertreated  or neglected, a problem that is paramount for people who have no health insurance or a policy that doesn’t adequately cover needed treatment. But for good people with good private health insurance or Medicare, the perils of over treatment are real.

Avoiding excessive testing and hospital stays is easier in some parts of the U.S. than in others where a “do more” medical culture prevails. We worked with the researchers at the Dartmouth Atlas to make their data on 2,878 hospitals available free at ConsumerReportsHealth.org. Use the tool to find out how hospitals in your area treat people with long-term, life-threatening illnesses. You will also find a link to Hospital Compare (www.hospitalcompare.hhs.gov), a Medicare project that rates hospitals by patient satisfaction and a variety of quality measures. And no matter where you live, get the right kind of care for serious illness by using the tips in the box at right.

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Vaccination part 2

January 19th, 2010

The second, thimerosal-containing vaccines cause autism. Third, MMR vaccines, without thimerosal, can cause autism. Since December 1999 the vaccines in Canada containing thimerosal is Hepatitis B, given to students in grade seven through the school system, and the flu shot (only if taken in multiple doses).

In the Omnibus Autism Proceedings court must make a legal ruling not scientific rulings. If there is a medical explanation of cause and effect linking the vaccination to injury of any kind, the cases will win. It is important to note, however, that each court is looking at medical probability instead of medical certainty.

However, in May 2004, the Institute of Medicine, a group of impartial US scientists concluded that any links between any vaccines containing thimerosal and autism are theoretical.

Many scientist believe that the only viable explanation is that the vaccines will only cause autism to those children who have an underlying disorder that it triggers.

The problem now becomes that parents are becoming increasingly skeptical of vaccinating their children in order to prevent them from becoming autistic. According to the Centers for Decease control and Prevention, as or September 2008, only less than one per-cent, of children between 19 and 35 months are not getting vaccinated. “The ongoing success of our nation’s [US] immunization program is largely dependent on the trust that parents put in the safety of vaccines and in those caregivers who administer them, “said CDC Director Julie Gerberding, MD, MPH, in a news release. ” I want to encourage parents to continue to be informed and to ask pediatricians about the safety of vaccines or any other concerns they may have about their child’s health.” Within the same research, The CDC found that of those children getting vaccinated, almost eight per-cent of children 19 to 35 months are not being vaccinated specifically against the measles. The CDC notes that this lack of coverage could explain the outbreaks of measles recently.

The children who are left unvaccinated could be picking up and spreading diseases that are now foreign to us, like the measles.

Most people believe that their school or daycare system will help to weed out those who are not vaccinated, but after contacting the Toronto District Public School Board, this doesn’t seam to be the case. Upon registering children, the school asks for immunization records. If they do not receive them, or they are not complete, the school need not do anything about it. It is not until Public Health request the information from the school in order to ensure everything is in order that there is concern raised with incomplete vaccination records. If the records are found to be incomplete, a letter is sent to the parents to update the medical records of the students. By this time, though, your children could have been in contact with diseases by those without up-to-date vaccination records.Peet, in a recent interview with Standford University, had a message for those considering not to vaccinate their children, “I hope parents understand that when they do not vaccinate their kids, they are able to make that choice only because most of us are vaccinating. We are creating a barricade around their un-vaccinated children and that is what keeps them safe.”To a vaccination schedule or more information on vaccines check your local public health office.

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Vaccination

January 16th, 2010

Recently, there has been a lot of celebrity discussion about the link to the autism and vaccines. Two Hollywood moms, Jenny Mc Carthy and Amanda Peet, have gone head to head trying to sway the public’s opinion. In 2005 Mc Carthy’s son, Evan, was diagnosed with autism. Since then she has been promoting the idea that childhood vaccinations, particularly the MMR vaccine ( used to prevent measles, mumps and rubella, given to babies between 12 to 18 months old), caused her son to develop austism. Peet, on the other hand, decided to do research of her own before vaccinating her daughter Frances Pen and is now an advocate for childhood vaccination through vaccinateyourbaby.org, a campaign designed to educate the public on the truth behind vaccinations. With such well-known public names taking such a very different sides, it’s hard to know who’s right.  A United States court was asked this exact question when parents of two 10-year-old boys claimed vaccinations triggered the boys autism. With the help of U.S. Department of Health and Human Services, it was determined that the vaccination could have aggravated an underlying mitochondrial disorder that, in turn, caused the symptoms of autism. The parents won the court case. Since then, a major trial has been ongoing the United States in order to determine if, in fact, this vaccinations could have any link to autism in the Omnibus Autism Proceedings. This case tests three theories of how vaccines cause autism, and hearing consist of three test subjects. The first theory is the ‘theory of causation,’ in which MMR vaccine and the vaccines containing thimerosal, a chemical used in vaccines in order to keep them from spoiling, combine to cause autism.

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Cutting Back on Caffeine

January 12th, 2010

Of course, it’s not just coffee moms-to-be should watch out for-caffeine is also found chocolate, soft drinks, tea and hot chocolate. In light of the study, the March of Dimes now recommends that pregnant women limit their intake to 200 milligrams or less per day-so it makes sense to choose your caffeine sources wisely.

Ordering decaf whenever possible is the safest way to enjoy your coffee. When decaf doesn’t cut it, espresso-based drinks contain less caffeine than brewed coffee. (A tall Starbucks latte has just 90 milligrams of caffeine.) Green tea is a good choice with just 40 milligrams of caffeine in a tall cup-less than half the caffeine in black tea. As for chocolate, this is one time when milk wins out over dark. A three-ounce piece of milk chocolate has just 18 milligrams of caffeine, while the same size of dark chocolate contains 60 milligrams.

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Why Caffeine Can Cause Problems?

January 9th, 2010

The San Francisco-based study found that caffeine might be dangerous to the developing fetus because it crosses the placenta. A fetus does not have a sufficient metabolic system to cope with the increase in heart rate that results from this jolt of caffeine. In severe cases, the result can be a spontaneous abortion. In less, severe cases, caffeine can contribute to low birth weight. Because the risk of miscarriage is highest in the first three or four months, caffeine intake should be most strictly monitored during early pregnancy.

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